Abstract
BackgroundThe absence of menstruation is common in women who use drugs. This can give a belief that conception is unlikely. When stabilised on Opioid Substitution Treatment (OST), fertility often returns, initially without realisation as ovulation precedes menstruation. This leaves women vulnerable to unplanned pregnancies. Community pharmacists (CPs) are frequently in contact with this patient group through the Supervised Consumption of OST service. This provides a timely opportunity to provide reproductive health (RH) advice. The aim of this study was to investigate pharmacists' views on providing a RH service to women receiving OST. MethodsTwenty semi-structured interviews based on the Capability-Opportunity-Motivation to Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) were conducted between 2016 and 2017. Data analysis involved deductive coding using the TDF domains. The TDF domains were mapped onto the elements of the COM-B and used in the second step to create the framework and chart the data. The third step involved re-reading and clustering the codes, and inductive themes were generated to explain the data in depth. ResultsNine of the 14 TDF domains, mapped into five elements of the COM-B, were identified. Five inductive themes were generated: 1) The pharmacists' experience and knowledge of reproductive health (RH) needs of women receiving OST, 2) The pharmacists' approach to providing advice, 3) The pharmacists' perception of the relationship with women receiving OST, 4) Social influences, and 5) Environmental factors. Community pharmacists feared causing offense to women receiving OST and described requiring cues as to when the service was needed. Pharmacists' highlighted a power imbalance in the relationship with women receiving OST. This could influence how receptive this patient group would be to pharmacy RH interventions. ConclusionsCPs' concerns of providing RH service could hinder a proactive service provision. Supporting good rapport and providing a structured consultation would increase the accessibility of such a service.
Highlights
In the UK, community pharmacists often supervise the consumption of Opioid Substitution Therapy (OST) in their pharmacies, especially in the early stage of opioid use disorder treatment.,[1,2] This supervised consumption service (SC)[3] provides the service user with regular contact with a health care professional, more frequently than others involved in their care
This study has identified a range of factors that could influence the provision of reproductive Health (RH) advice/service to women receiving Opioid Substitution Treatment
The study revealed the challenges pharmacists perceived if required to proactively provide a reproductive Health (RH) service, and their perception was subject to reflective motivation
Summary
In the UK, community pharmacists often supervise the consumption of Opioid Substitution Therapy (OST) (e.g. methadone, buprenorphine) in their pharmacies, especially in the early stage of opioid use disorder treatment.,[1,2] This supervised consumption service (SC)[3] provides the service user with regular contact with a health care professional (the pharmacist), more frequently than others involved in their care In this context, the Department of Health described that role as “providing an opportunity for the pharmacist to build a therapeutic relationship with the patient that is beneficial to promote health and harm reduction, (p.102)”.4. Supporting good rapport and providing a structured consultation would increase the accessibility of such a service
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